A first: Baby with HIV is 'functionally cured'

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Mar 3, 2013 at 3:38 PMMar 3, 2013 at 9:38 PM

By Lisa Eckelbecker TELEGRAM & GAZETTE STAFF

An infant born with the virus that causes AIDS was “functionally cured” after receiving early, aggressive drug treatment, according to a research team that includes a University of Massachusetts Medical School professor.

The child, a girl born in Mississippi and now 2 1/2 years old, is healthy and in long-term remission, said the researchers, who will present their findings Monday at a medical conference in Atlanta. Traces of the virus known as HIV have been detected in the child using highly sensitive tests, but the virus has not replicated after the child stopped taking medication, said Dr. Katherine F. Luzuriaga, UMass professor and immunologist.

“What we are hypothesizing happened is that by treating this child within days of birth, we were able to minimize the generation of reservoirs,” cells in the body that harbor genetic code for the virus known as HIV, said Dr. Luzuriaga. “And in that scenario, the period of treatment was sufficient to again reduce those reservoirs to the point where, when this child did come off antiretroviral therapy, they were able to maintain control of whatever little virus there may be.”

The researchers discussed their findings today at a news conference in Atlanta. Also on the research team are lead author Dr. Deborah Persaud of Johns Hopkins University School of Medicine in Baltimore and pediatrician Dr. Hannah Gay of the University of Mississippi Medical Center in Jackson. Dr. Gay treated the baby, who was not identified.

HIV can be transmitted through sex, blood transfusions and shared intravenous needles. Infected women can pass the virus to their babies in the womb, during childbirth and through breast milk. When left untreated, HIV destroys an individual's immune system and leads to death.

U.S. public health officials estimate there were 10,834 HIV-infected individuals younger than 13 in the 46 states that report data as of 2009, and 88 percent of those children were infected at birth.

Women can reduce the likelihood of passing HIV to their babies by taking antiretroviral drugs during pregnancy, however, the Mississippi baby was born to a mother who did not know she was infected and had not taken medication to control the virus, the researchers said. The baby's risk of infection was high, so Dr. Gay started the newborn on the drugs AZT, epivir and nevirapine when she was just 30 hours old, according to Dr. Luzuriaga. Tests later confirmed the infant was infected.

“Since the baby was infected and was already on a treatment regimen, the antiviral medicines were continued with the intent that they would be given for a lifetime,” Dr. Gay wrote in a statement released by the University of Mississippi. “The viral load in the baby's blood fell while on the medicine as was expected and actually fell to below the level of detection of our clinical test within less than a month.”

The child remained on medication and was taken to doctors for regular visits for more than a year. Doctors lost contact with the child for five months, however, catching up with the mother and baby when the child was 23 months old and had been off medication for about five months.

Ordinary tests showed no sign of HIV in the child, but some highly sensitive procedures known as assays detected it, according to Dr. Luzuriaga.

The researchers are preparing a paper on their findings for submission to peer-reviewed research journals. They said they do not have enough information to recommend changes to the way HIV-infected newborns are treated.

“This is one case,” Dr. Luzuriaga said. “It's generated a lot of excitement. It's generated hypotheses for future testing, and I think that's what's going to be important, future testing on this baby and then additional clinical trials to see whether we can replicate this in other children.”

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